The following abstract is from an article authored by Dr. David Sugarbaker of the Brigham and Womens Hospital in Boston. It is noteworthy that the patients with epithelial tumors generally have a significantly longer mean survival than the patients with mixed type/sarcomatous tumor.

Resection Margins, N2 status and Cell type Determine Survival in Trimodality Therapy of Malignant Pleural Mesothelioma (MPM):

 

Objectives: We review our experience with extrapleural pneumonectomy (EPP) in the multimodality management of MPM.

Methods: From 1980 to 1997, 183 consecutive patients underwent trimodality therapy involving EPP followed by adjuvant chemotherapy and radiotherapy. Standardized systematic pathologic analysis was undertaken.

 
Results: The cohort included 43 women and 140 men with a mean age of 57 years (range 31-76) and a median follow-up interval of 13 months. Overall survival was 36% at 2 yrs and 14% at 5 yrs (median 17 mo.). There were seven perioperative deaths (3.8% mortality). Factors affecting long-term survival were evaluated in 176 patients surviving surgery (among these, survival was 38% at 2 yrs and 15% at 5 yrs; median 19 mo.). As indicated in the table below, lack of N2 nodal involvement, negative resection margins and epithelial histology were associated with improved survival. Factorial grouping by N2 status and resection margins significantly stratified survival among all patients surviving surgery (p<0.02), and among those with epithelial histology (p<.02). Thirty-one patients with epithelial tumors, negative resection margins and without N2 involvement had a 51 mo. median survival (68% 2-yr, 46% 5-yr). A clinico-pathologic staging system previously published stratified survival (p<0.05; see table).

 

 

Variable	N	2-Year	5-Year	Median(months)	P Value
Epithelial	103	52%	21%	26	0.0001
Mixed/Sarcom	73	16%	0%	13
Margins(+)	110	33%	9%	15	0.02
Margins(-)	66	44%	25%	23
N2(+)	40	23%	0%	14	0.004
N2(-)	136	42%	17%	21
Epithel.N2(+)	21	38%	0%	20	0.052
Epithel.N2(-)	82	56%	24%	34
Epithel.N2(+) Marg(+)	12	29%	0%	14	0.013
Epithel.N2(+) Marg(-)	9	43%	0%	22
Epithel.N2(-) Marg(+)	51	49%	14%	22
Epithel.N2(-) Marg(-)	31	68%	46%	51
StageI	66	53%	20%	25	0.048
StageII	41	44%	14%	20
StageIII	69	17%	14%	16